PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer
To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE).
Materials and Methods
From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%.
Of the 68 post-RE scans, 6 were performed at 0–30 days, 15 at 31–60 days, 9 at 61–90 days, 13 at 91–120 days, 14 scans at 121–180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30–90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders.
In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30–90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.
KeywordsBreast cancer Radioembolization Liver metastasis PET/CT imaging
This research was partly funded through the NIH/NCI Cancer Center Support Grant P30 CA008748 and the Breast Cancer Research Foundation.
Compliance with Ethical Standards
Conflict of interest
Dr. Deipolyi reports personal fees from BTG, Inc., personal fees from Dova Pharmaceuticals, outside the submitted work. Dr. Boas is a co-founder of Claripacs, LLC, and received a research grant and supplies from Guerbet, research support from GE, research supplies from Bayer, and a research grant and speaker fees from Society of Interventional Oncology, sponsored by Guerbet; he is also an investor in Labdoor, Qventus, CloudMedx, Notable Labs, and Xgenomes. Dr. Yarmohammadi received research grants from the Thompson Foundation and Guerbet. Dr. Sofocleous received consulting fees from Terumo and consulting fees and research funding from BTG and Johnson and Johnson. The other authors have no disclosures.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.
This study has obtained institutional IRB approval, and the need for informed consent was waived due to its retrospective nature.
Consent for Publication
For this type of study, consent for publication is not required.
- 3.De Souza A, Daly KP, Yoo J, Saif MW. Safety and efficacy of combined yttrium 90 resin radioembolization with aflibercept and FOLFIRI in a patient with metastatic colorectal cancer. Case reports in oncological medicine. 2015.Google Scholar
- 11.Edalat F, Camacho JC, Kokabi N, Kendi AT, Galt JR, Kim HS. Standardized added metabolic activity predicts survival after intra-arterial resin-based 90Y radioembolization therapy in unresectable chemorefractory metastatic colorectal cancer to the liver. Clin Nucl Med. 2016;41:e76–81.CrossRefGoogle Scholar
- 14.Jongen JMJ, Rosenbaum C, Braat M, et al. Anatomic versus metabolic tumor response assessment after radioembolization treatment. J Vasc Interv Radiol. 2018;29(244–53):e2.Google Scholar
- 16.Piduru SM, Schuster DM, Barron BJ, Dhanasekaran R, Lawson DH, Kim HS. Prognostic value of 18f-fluorodeoxyglucose positron emission tomography-computed tomography in predicting survival in patients with unresectable metastatic melanoma to the liver undergoing yttrium-90 radioembolization. J Vasc Interv Radiol. 2012;23:943–8.CrossRefGoogle Scholar
- 20.Riedl C, Pinker K, Ong L, et al. Comparison of FDG-PET/CT with contrast enhanced CT for prediction of progression-free and disease-specific survival in stage IV breast cancer patients: a retrospective analysis. J Nucl Med. 2015;56:1320.Google Scholar
- 22.National Comprehensive Cancer Network. Breast Cancer. Version 2.2017.Google Scholar
- 23.Deipolyi AR, Riedl CC, Bromberg J, et al. Association of PI3K pathway mutations with early positron-emission tomography/CT imaging response after radioembolization for breast cancer liver metastases: results of a single-center retrospective pilot study. J Vasc Interv Radiol. 2018;29:1226–35.CrossRefGoogle Scholar
- 30.Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional therapies for the treatment of hepatic metastases from breast and gynecologic cancers. Seminars in interventional radiology. New York: Thieme Medical Publishers; 2018. p. 29–034.Google Scholar